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目的探讨再灌注方式对急性前壁ST段抬高心肌梗死(STEMI)的心电图特征与心肌酶学变化之间的关系。方法 2010年1月至2012年12月急性前壁STEMI患者216例,均行急诊或择期完全血运重建术,资料完整、符合纳入标准的156例均连续入选。依据12 h内是否行急诊介入和静脉药物溶栓,分为早期再灌注组(n=102)和延迟再灌注组(n=54)。收集研究对象的临床资料,心电图和心肌酶学变化。定量资料正态性检验选择Kolmogorov-Smirnova检验,组间分布的比较选择Mann-Whitney U检验,均数比较选择t检验。率或构成比的比较,选择χ~2检验。结果早期再灌注组和延迟再灌注组,年龄[(60.3±12.5)岁比(60.2±12.5)岁]、男女比例[83.3%(83/102)比75.9%(41/54)],差异无统计学意义(P>0.05);但早期再灌注组急性期Killip 2~4级发生率较高[40.0%(43/102)比3.7%(2/54)]、早期再灌注组心肌酶学峰值均高于延迟再灌注组(P<0.01)。酶学达峰时间比延迟再灌注组达峰时间明显缩短[(11.3±2.1)h比(17.4±4.6)h,P<0.01]。左心室射血分数、左心室直径与肌酸磷酸激酶同功酶,肌钙蛋白密切相关(r分别为-0.74、-0.79和0.54、0.60,P<0.01)。心电图前壁导联ST段抬高幅度之和、Q波之和以及Q波导联数,前壁ST段抬高最大值,与Killip分级、心肌酶峰值、脑钠肽呈正相关(r=0.41~0.62,P<0.05)。结论急性前壁STEMI患者心电图Q波、ST段、R波、心肌酶峰值与左心室射血分数、左心室直径密切相关。除左心室射血分数外,早期再灌注组优于延迟再灌注组。
Objective To investigate the relationship between electrocardiogram (ECG) changes and myocardial enzymology in acute anterior ST-segment elevation myocardial infarction (STEMI) after reperfusion. Methods A total of 216 patients with STEMI in the anterior wall from January 2010 to December 2012 were enrolled in this study. All patients underwent emergency or elective revascularization. The data were complete and 156 cases met the inclusion criteria. Patients were divided into early reperfusion group (n = 102) and delayed reperfusion group (n = 54) according to whether emergency intervention and intravenous drug thrombolysis occurred within 12 h. Subjects were collected for clinical data, electrocardiogram and myocardial enzymology changes. Kolmogorov-Smirnova test was used to test the normality of quantitative data, and Mann-Whitney U test was used to compare the distribution among groups. The mean was compared with t-test. Rate or composition ratio, select χ ~ 2 test. Results The rates of age (60.3 ± 12.5) years old (60.2 ± 12.5) years old, 83.3% (83/102) vs 75.9% (41/54)] in early reperfusion group and delayed reperfusion group were significantly different (P> 0.05). However, the incidence of Killip grade 2 ~ 4 in acute reperfusion group was higher than that in early reperfusion group [40.0% (43/102) vs 3.7% (2/54) The peak value was higher than delayed reperfusion group (P <0.01). The peak time of enzymology was significantly shorter than that in the delayed reperfusion group [(11.3 ± 2.1) h vs (17.4 ± 4.6) h, P <0.01]. Left ventricular ejection fraction and left ventricular diameter were closely related to creatine phosphokinase isoenzyme and troponin (r = -0.74, -0.79 and 0.54, 0.60 respectively, P <0.01). The sum of ST segment elevation, Q wave summation, Q wave number, and ST segment elevation in the anterior wall were positively correlated with Killip classification, myocardial enzyme peak and brain natriuretic peptide (r = 0.41 ~ 0.62, P <0.05). Conclusion The Q wave, ST segment, R wave and peak of myocardial enzymes in patients with STEMI in acute anterior wall are closely related to left ventricular ejection fraction and left ventricular diameter. In addition to left ventricular ejection fraction, early reperfusion group than delayed reperfusion group.